ALL PERMITS ARE ISSUED ONLY AFTER A SATISFACTORY BACKGROUND INVESTIGATION. YOU WILL BE NOTIFIED BY MAIL OF THE PERMIT ISSUANCE OR DENIAL.

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1 THE COUNTY OF CHESTERFIELD VIRGINIA CHESTERFIELD COUNTY POLICE DEPARTMENT IRON BRIDGE ROAD, CHESTERFIELD, VA APPLICATION FOR PRECIOUS METAL DEALERS PERMIT NON TRANSFERABLE Application Fee: $ (NON-REFUNDABLE-FIRST TIME) Renewal Application Fee: $ (NON-REFUNDABLE-RENEWAL ONLY) Checks: Payable to TREASURER, CHESTERFIELD COUNTY INTRODUCTION: Along with this completed application, you must attach a bond secured by corporate surety, payable to the County of Chesterfield in the sum of ten thousand dollars ($10,000) and conditioned upon due observance of the terms of Chesterfield County Ordinance through An original application fee of $237.00, payable to the Treasurer of Chesterfield County, must be paid to the County Treasurer s Office, following which you will be fingerprinted and photographed. ALL PERMITS ARE ISSUED ONLY AFTER A SATISFACTORY BACKGROUND INVESTIGATION. YOU WILL BE NOTIFIED BY MAIL OF THE PERMIT ISSUANCE OR DENIAL. Applicant s Full Legal Name Last Name First Name Middle Name Aliases: Home Address: City: State: Zip Code: Home Telephone: Social Security Number: Cell Phone: Sex: Male Female Race: Date of Birth: Height: Weight: Hair Color: Eye Color: Business Name: Business Address: City: State: Zip Code: Business Phone: Business If partnership or corporation, list partners or corporate officers: PD86 Rev 1/2014 Page 1 of 6

2 List 3 references (local, if possible, non relative) Name Address, City, State and Zip Home Telephone Work Telephone Have you ever been convicted of a Felony? No: Yes: Date: Jurisdiction (Place): State: Nature of the Felony: Please furnish information on any criminal charges you have received, whether as a juvenile or adult, other than traffic offenses. Please list the date and jurisdictions in which the charge occurred. (If more space is needed, attach a separate sheet): Date Criminal Charge Jurisdiction Convicted No No No Yes Yes Yes I have received a copy of the Chesterfield County Ordinance through relating to the regulation of Dealers in Precious Metals. I hereby certify that there are no willful misrepresentations in or falsifications of the above statements and answers to questions. I am aware that should the investigation disclose such omissions or misrepresentations and falsifications, my application will be rejected. Signature of applicant: Date: Please Note: You must apply for renewal of this permit every 12 months. A renewal fee of $ is required. PD86 Rev 1/2014 Page 2 of 6

3 Chesterfield County, Virginia Police Department Police Personnel Unit Iron Bridge Road P.O. Box 148 Chesterfield, VA Phone: (804) Fax: (804) Internet: chesterfieldpd.gov COLONEL Thierry G. Dupuis Chief of Police AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION I,, authorize a review of and full disclosure of all records, or any part thereof, concerning myself, by a duly authorized agent of the Chesterfield County Police Department whether the said records are of public, private or confidential nature. The intent of this authorization is to provide full and free access to the background and history of my personal life, for the specific purpose of pursuing a background investigation, which may provide pertinent data for the Chesterfield County Police Department to consider in determining my suitability for this permit or license. It is my specific intent to provide access to personal information, however personal or confidential it may appear to be. I understand that any information obtained by a personal history background investigation, which is developed directly or indirectly, in whole or in part, upon this release authorization will be considered in determining my suitability for this permit or license. I agree to indemnify and hold harmless the person to whom this request is presented and his/her agents and employees, from and against all claims, damages, losses and expenses, including reasonable attorney fees arising out of or by reason of complying with this request. I further understand that in the event my application is disapproved, the sources of confidential information cannot be revealed to me. A photocopy of this release form will be valid as an original hereof, even though the said photocopy does not contain an original writing of my signature. Date Signature (sign before a notary public) Commonwealth of Virginia, County of Chesterfield. Acknowledged before me this day of, 20. Notary Public Signature Notary Number Commission Expiration Date PD113-P Rev 08/2014 Page 3 of 6

4 THE COUNTY OF CHESTERFIELD VIRGINIA CHESTERFIELD COUNTY POLICE DEPARTMENT CRIMINAL RECORD REQUEST Unit Number Employment Permit Print all the requested information CLEARLY. If an item of information is not applicable, print N/A in the item space. Last Name First Name Full Middle Name Month Day Year Alias and/or Nickname Date of Birth Social Security Number Place of Birth (City/Town) State of Birth Country of Birth Current Driver s License Number State of Issue Race Sex Age Feet Inches Previous Driver s License Number State of Issue Height Weight Hair Color Eye Color Complexion (Light, Med, Dark or Olive) Current Home Address City State/Country Zip Code Previous Home Address City State/Country Zip Code Home Phone Number Business Phone Number Cell Phone Number Address ARTICLE VII. PRECIOUS METAL DEALERS* PD75 Rev 01/2014 Page 4 of 6

5 *State law references: Generally, Code of Virginia, et seq.; authority for county ordinances, Code of Virginia, ; pawnbrokers, Code of Virginia, et seq. Sec Definitions. For the purposes of this article, the following words shall have the following meanings: Chief of police: The Chesterfield County Police Chief or his designee. Coin: Any piece of gold, silver or other metal fashioned into a prescribed shape, weight and degree of fineness, stamped by authority of a government with certain marks and devices and having a certain fixed value as money. Dealer: Any person engaged at any location in the county in the business of purchasing precious metals or gems or making loans for which precious metals or gems are received and held as security except: (i) retail merchants personally located within the county when they make purchases directly from manufacturers or wholesalers of precious metals or gems for the retail merchants' inventories and the selling dealer has complied with the provisions of this article, and (ii) refiners of precious metals who make purchases directly from wholesalers, retailers or out-of-state vendors. "Dealer" shall include merchants whose business is itinerant in the county. "Dealer" shall also include employers and principals on whose behalf the purchase or loan was made and all employees and agents who personally make such purchases and loans. When any act is required of a corporation, it shall be considered performed by its president. Gem: Any item containing or having any precious or semiprecious stones customarily used in jewelry or ornamentation. Precious metal: Any item except coins containing as part of its composition any gold, silver, platinum, platinum alloys or pewter. (Code 1978, ; Ord. of , 1) Cross references: Definitions and rules of construction generally, 1-2. Sec Permit--Required. No dealer shall purchase precious metals or gems or make loans for which precious metals or gems are received and held as security without first obtaining a permit from the chief of police as provided herein and without complying with all other provisions of this article. Possession of a permit issued in another locality shall not relieve a dealer of the obligation to obtain a permit from the chief of police. (Code 1978, ; Ord. of , 1) Sec Same--Method of obtaining. (a) The permit required by this article shall be issued by the chief of police upon payment of a $ application fee and satisfaction of the requirements of this article. The applicant will provide written authorization to conduct a background investigation, including fingerprints and personal descriptive information for the purpose of obtaining criminal history record information, the costs of which shall be borne by the applicant. The fingerprints shall be forwarded to Virginia State Police for processing through the Central Criminal Records Exchange to the Federal Bureau of Investigation as authorized by Code of Virginia, A permit will not be issued if the applicant has been convicted within the last ten years from the date of the application of a felony or any other crime materially affecting the applicant's ability to conduct the permitted activity including a crime of moral turpitude, or if the applicant has been denied a permit or has had a permit revoked under any statute or ordinance similar in substance to the provisions of this article. Information required on the application shall include, but not be limited to, the applicant's full name, aliases, address, age, sex, race, Social Security Number, date of birth; the name, address and telephone number of the applicant's employer, if any; and the location of the place of business of the dealer. The applicant shall date and sign the application and certify that the information contained in the application is true and correct. Before a permit is issued, the dealer must have all weighing devices used in his business inspected and approved by local or state weights and measures officials and present written evidence of such approval to the chief of police. (b) No license shall be valid for more than 12 months from the date of issuance. Any license may be renewed in the same manner as the initial license is obtained. The renewal application fee shall be $ (c) If the dealer does not operate continuously at the same location after the date when he obtains the permit, he shall notify the chief of police when he ceases or renews business or upon change of his location. Failure to operate on weekends or holidays shall not be construed as ceasing or discontinuing operation. The dealer shall conduct his business only from the fixed and permanent location specified in the dealer's application for a permit. (Code 1978, ; Ord. of , 1; Ord. of (1), 1; Ord. of , (2)) Sec Same--Nontransferable and to be displayed. The permit shall be a personal privilege and shall not be transferable. There shall not be any reduction in the fee for the permit because the dealer exercises the privilege of the permit for a period of time less than that for which it was granted. The dealer shall at all times prominently display the permit on his business premises. (Code 1978, ) Sec Same--Revocation. (a) The chief of police may revoke a dealer's permit if such dealer violates any reporting or recordkeeping requirements of this article or if such dealer is convicted by any court for violating any provision of this article. (b) Any false statement made on the application form voids the permit as if it had never been issued. Page 5 of 6-

6 (Code 1978, , ; Ord. of , (2)) Sec Information from sellers or borrowers. Dealers shall ascertain the full name, residence address, work address, home and work telephone numbers, age, height, weight, date of birth, race, gender, hair and eye color, and other identifying marks of sellers of precious metals or gems or borrowers offering precious metals or gems as security therefor and shall require the seller or borrower to verify his identification through two forms of identification, one of which must be a photo identification issued by a governmental agency. Dealers shall record the type of identification offered, including the issuing agency and the number thereon. (Code 1978, ) Sec Records, copies of bills of sale required; right of entry of law-enforcement officials. (a) Every dealer shall maintain adequate records to reflect the information listed below which shall appear on bills of sale. The form of the bill of sale shall be provided by the chief of police. One copy of the bill of sale shall be retained by the dealer for not less than 24 months, one copy shall be delivered during regular county work hours to the chief of police at his office within 24 hours of the sale and one copy shall be delivered to the seller of such precious metals or gems or borrower whose loan is secured by precious metals or gems. If the purchase or loan occurs during a weekend then the delivery to the chief of police shall be made no later than 10:00 a.m. of the next regular county work day. Every dealer shall furnish the information required by this section in a manner prescribed by the chief of police, which may include electronic format. The required information is as follows: (1) The name of the dealer and his employer or principal, if any. (2) A complete description of each item, including weight, and all names, initials, serial numbers or other identifying marks or monograms appearing on the items and the price paid for each item. (3) The date, time and place of receiving the items. (4) The name, residence address and phone number, work address and telephone number, age, sex, race, height, weight, hair and eye color, other identifying marks, date of birth, driver's license number or Social Security Number and signature of the seller or borrower. (5) Verification of the identification of the seller or borrower, including the type of identification exhibited, the issuing agency and the number thereon. (6) A statement of ownership from the seller or borrower. (b) In addition to the information required to be maintained in subsection (a), every dealer shall also maintain within its records a photograph of each item received. (c) Every dealer shall admit to his premises during regular business hours the chief of police, his sworn designee, or any law-enforcement official of the state or federal governments, and shall permit the chief of police or other such law-enforcement official (i) to examine all records required by this article and any item listed in a record which is believed by the chief of police or official to be missing or stolen, and (ii) to search for and take into possession any item known to him to be missing or known or believed by him to have been stolen. (Code 1978, ; Ord. of , (2)) Sec Prohibited purchases. No dealer shall purchase from or make a loan secured by precious metals or gems to any person who is under the age of 18. No dealer shall purchase from or make a loan secured by precious metals or gems to anyone whom the dealer believes or has reason to believe is not the owner of such precious metals or gems, unless the seller or borrower has written, signed and authenticated authorization from the owner permitting and directing such sale. (Code 1978, ) Sec Dealer to retain purchases. (a) The dealer shall retain all precious metals or gems purchased or given as security for a loan for a minimum of 15 calendar days from the time of filing the bill of sale with the chief of police. During such period of time the dealer shall not sell, alter or dispose of any item containing precious metals or gems, in whole or in part, or remove such items from the county. (b) Each dealer shall keep and maintain for at least 24 months after the waiting period required by subsection (a), an accurate and legible record of the name and address of the person to whom he sells any precious metal or gem in its original form. This record shall also show the name and address of the seller or borrower from whom the dealer obtained such item. (Code 1978, ; Ord. of , (2)) Sec Dealer's bond; availability of bond proceeds. (a) Prior to submitting his application, every dealer shall obtain and deliver to the county a bond secured by corporate surety authorized to do business in this commonwealth. The bond shall be payable to the county in the penal sum of $10, and conditioned upon due observance of the terms of this article. (b) Any person who suffers a loss due to the dealer violating the provisions of this article and who recovers a final judgment against the dealer for such loss may maintain an action in his own name upon the bond or surety. (Code 1978, , ) Sec Penalty. Any person convicted of violating any of the provisions of this article shall be guilty of a class 2 misdemeanor for the first offense. Upon conviction of any subsequent offense he shall be guilty of a class 1 misdemeanor. (Code 1978, ) Page 6 of 6

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